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VOLUME 6 , ISSUE 3 ( September-December, 2017 ) > List of Articles

RESEARCH ARTICLE

Laparostomias No Hospital João XXIII: Análise Das Indicações e Resultados

Gabriela Duarte Costa Constantino, Rodrigo Marques de Oliveira, Amanda Baraldi de Souza Araújo, Domingos André Fernandes Drumond

Citation Information : Constantino GD, Oliveira RM, Araújo AB, Fernandes Drumond DA. Laparostomias No Hospital João XXIII: Análise Das Indicações e Resultados. Panam J Trauma Crit Care Emerg Surg 2017; 6 (3):190-200.

DOI: 10.5005/jp-journals-10030-1191

License: CC BY 3.0

Published Online: 00-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objetivo

Análise, através de amostragem, dos aspectos envolvidos na condução dos pacientes laparostomizados.

Materiales y Métodos

Estudo prospectivo tipo série de casos. Há mais de 15 anos o serviço tem aprimorado seu protocolo em relação à laparostomia. De março/2014 a março/2016, 60 pacientes foram conduzidos em laparostomia no serviço de cirurgia geral e do trauma do Hospital Pronto Socorro João XXIII (HPSJXXIII) da Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), objeto desse estudo.

Resultados

A maioria dos pacientes era jovem, média de idade de 33 anos e do sexo masculino 50 (83%). O mecanismo de trauma mais frequente foi o penetrante 32 (53%). O ISS maior que 16, observado em 80% dos casos, define alto percentual de pacientes graves. A instabilidade hemodinâmica foi detectada em 39 (65%) pacientes e 24 (40%) foram encaminhados ao centro cirúrgico em caráter de emergência. O controle de danos foi realizado em 53 (88%) das laparostomias. Ao final da primeira intervenção, a Bolsa de Bogotá foi o fechamento temporário do abdome realizado em 100% dos casos dos laparostomizados. Curativo com pressão negativa foi realizado em 13 (22%) dos pacientes. Algum tipo de complicação abdominal ocorreu em 36 (60%) dos casos. A fístula intestinal foi a complicação mais grave, observada em 8 (13%) pacientes. O óbito foi o desfecho final em 27 (45%) pacientes do estudo.

Conclusão

Nos últimos anos, a análise dos laparostomizados tem aguçado preocupação na condução desses pacientes no serviço. A morbimortalidade é significativa e cada vez mais há evidências de que os vieses no controle de danos acabam influenciando decisivamente nos resultados. A complacência na indicação dos procedimentos de controle de danos deve ser reavaliada nos serviços de trauma.

Relevância clínica

O crescimento do “damage control” aumentou muito a indicação de laparostomias. O abdome aberto tem benefícios bem estabelecidos no manejo de pacientes instáveis, porém, associa-se a grandes complicações e a um alto índice de morbimortalidade. É necessário maiores discussões acerca do tema e desenvolvimento de protocolos específicos, cada vez mais concisos, levando-se em conta os recursos humanos e materiais de cada instituição.

How to cite this article

Constantino GDC, Drumond DAF, de Oliveira RM, de Souza Araújo AB. Laparostomias No Hospital João XXIII: Análise Das Indicações e Resultados. Panam J Trauma Crit Care Emerg Surg 2017;6(3):190-200.

Objective

To analyse the aspects involved in the management of laparostomized patients by sampling.

Materials and methods

A prospective study of a series of cases was conducted. For more than 15 years, the service has improved its protocol regarding laparostomy. From March 2014 to March 2016, 60 patients were submitted to laparostomy in the General Surgery and Trauma's Service of the Hospital Pronto Socorro João XXIII (HPSJXXIII) of the Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), as object of this study.

Results

The majority of patients (50 [83%]) were young male and the mean age was 33 years. The predominant mechanism of trauma was penetrating 32 (53%). The injury severity score (ISS) greater than 16, observed in 80% of the cases, defines a high percentage of critical patients. Hemodynamic instability was detected in 39 (65%) patients and 24 (40%) were referred to the operating room as emergencies cases. The damage control method was performed in 53 (88%) of the laparostomies. At the end of the first intervention, the Bolsa de Bogotá was the temporary closure of the abdomen performed in 100% of the laparostomized cases. Negative pressure wound therapy was performed in 13 (22%) patients. Some kind of abdominal complication occurred in 36 (60%) cases. Intestinal fistula was the most severe complication observed in 8 (13%) patients. Death was the final outcome in 27 (45%) patients in the study.

Conclusion

In the last years, the study of laparostomized patients has driven interest in the management of these patients in our service. Morbidity and mortality are significant among these cases and there is growing evidence that the damage control method and its biases ultimately influences outcomes. Compliance in the indication of damage control procedures should be reevaluated in trauma services.

Clinical significance

The growth of “damage control” has greatly increased the indication of laparostomies. The open abdomen has well-established the benefits in managing unstable patients, but it is associated with major complications and a high morbidity and mortality rate. Further discussion on this topic and development of specific, increasingly concise protocols are required, taking into account the human and material resources of each institution.


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